title: Stenting versus medical treatment for severe symptomatic intracranial stenosis.
abstract: OBJECTIVE
  Intracranial atherosclerosis is especially prevalent in Asians, but intracranial stent placement and medical treatment for severe intracranial stenosis are controversial. Thus, we compared long-term outcomes of these 2 therapeutic approaches in an Asian population.
  
  
  METHODS
  Patients with angiographically proved severe (≥70%) symptomatic intracranial atherosclerosis, with or without stent placement, were retrospectively reviewed at a single center between 2002 and 2009, with adjustments for age, sex, vascular risk factors, degree of baseline stenosis, and baseline functional status.
  
  
  RESULTS
  Of the 114 patients followed from 3 to 36 months (mean, 17.3 months) after initial diagnosis, 53 received 56 stents in addition to medical treatment (stent-placement group), and 61 matched patients received only medical treatment (medical group). Total clinical events, including stroke, TIA, and vascular death, were 12 (22.6%) and 15 (24.6%) in the stent-placement and medical groups, respectively (P = .99). The stent-placement group had significantly better functional outcomes than the medical group (94.3% versus 78.7% for mRS scores of 0-3, P = .045). Most events in the stent-placement group occurred within the first week of the periprocedural period (17.0%) as minor embolic or perforator infarctions, and the rate of events decreased thereafter (5.7%, P = .07). Stent placement over the perforator-rich MCA and BA independently predicted periprocedural events on multivariate regression analysis. In the medical group, events increased in frequency (21.7%) and severity with time.
  
  
  CONCLUSIONS
  Although the total ischemic event rate was similar in the 2 groups during a 3-year follow-up, the stent-placement group had a more favorable functional outcome despite minor periprocedural strokes.
authors.affiliation: Department of Neurology, Suao Veterans Hospital, Yilan County, Taiwan.
authors.forename: C-W
authors.initials: CW
authors.lastname: Tang
authors.forename: F-C
authors.initials: FC
authors.lastname: Chang
authors.forename: C-M
authors.initials: CM
authors.lastname: Chern
authors.forename: Y-C
authors.initials: YC
authors.lastname: Lee
authors.forename: H-H
authors.initials: HH
authors.lastname: Hu
authors.forename: I-H
authors.initials: IH
authors.lastname: Lee
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D015995:Prevalence; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome